Research finds link between prior depression and severity of symptoms during perimenopause

The research in the Journal of Affective Disorders was part of the Swiss Perimenopause Study: a large prospective, 1-year longitudinal research project conducted at the Department of Clinical Psychology and Psychotherapy at the University of Zurich.¹

The population-based sample for the cross-sectional analysis consisted of 135 perimenopausal women, aged 40 to 56 years, who participated in the study. Subjects were recruited between June 2018 and December 2019 through various channels, such as mailing lists, social media, and newsletter articles.

A good to excellent self-reported health status at study enrollment was required.

Among the 135 women, 43.7% were early perimenopausal and 56.3% were late perimenopausal. In addition, slightly more than half of the cohort (56.3%) was married.

All women were either Swiss (n = 105), German (n = 8) or Austrian (n = 1). However, despite efforts to recruit women from different socioeconomic backgrounds, participants were overall well-educated, with 54.5% reporting an academic degree, compared with 44.5% in the Swiss population, and had a higher socioeconomic status.

A history of depression was surmised if a woman had been previously diagnosed by a mental health expert such as a psychiatrist or a psychotherapist, or as a self-report complying with the criteria for major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

A wide range of validated psychosocial questionnaires were used to compare women with and without prior depression.

Overall, 40% of the study group had experienced at least one depressive episode in the past, whereas 60% did not indicate a history of depression.

Women with prior depression showed significantly more depressive symptoms (Mann-Whitney U-test [U]= 1215.5; P < 0.01), more menopausal symptoms (U = 1395.0; P < 0.01) and more sleep disturbances (U = 1583.5; P < 0.05) than women without prior depression.

Women with a history of depression also rated their own mental health worse (U = 1573.0; P < 0.05) and felt more isolated (U = 1524.0; P < 0.05) than those without prior depression.

“We assumed that females with prior depression would struggle significantly more during the menopausal transition, as reflected by greater levels of suffering in the perimenopause, more frequent negative health outcomes, and limited subjective well-being,” wrote the authors. “Indeed, we found increased burdensome symptoms in women with a history of depression.”

However, there were no significant differences in perceived stress, coping or self-esteem between women with and without prior depression.

Noteworthy, though, is that women with prior depression reported higher scores on instrumental social support compared with women without prior depression; hence, social isolation and helplessness during past depressive episodes might have increased the perceived social support.

The study’s findings underscore the need to consider a woman's mental health history during evaluation, education, and treatment of symptoms linked to the menopausal transition.

Moreover, because a woman's sensitivity to hormonal changes has been suggested as an influential factor in the relationship between depression and perimenopause, endocrinological factors as predictors of depressive symptoms should be considered for future research, according to the authors.

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Reference

1. Willi J, Süss H, Grub J, et al. Prior depression affects the experience of the perimenopause - findings from the Swiss Perimenopause Study. J Affect Disord. Published online September 2, 2020. doi:10.1016/j.jad.2020.08.062